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Case Study
Cycling Against Hip Pain (CHAIN) programme
Pedal power restores freedom and mobility for
people with hip arthritis
Partners:
BH Live
Royal Bournemouth and
Christchurch Hospitals NHS
Foundation Trust (RBCHFT)
Dorset Clinical Commissioning
Group
Active Dorset
Bournemouth Borough Council
Bournemouth University
Website:
bhlive.org.uk/leisure
Base:
Bournemouth, Dorset
Industry:
Healthcare
Project:
Six-week exercise and
education programme for
people with hip arthritis
________________________
Results:
Less pain and improved
function, strength and walking
ability
Increased range of hip motion
Improved wellbeing and
exercise confidence
Finalist for ukactive and Matrix
Flame Awards 2014: Healthy
Partnership Project Award
A pioneering programme
launched in Bournemouth
shows how exercise can
improve mobility, reduce pain
and make life easier for people
suffering from hip arthritis.
a year, at a cost of over £400
million. A further 25,000
procedures are carried out in
independent hospitals.
The challenge
There is evidence that exercise (in
addition to patient education)
could reduce the need for hip
surgery by up to 44 per cent,
reduce pain and improve function
in those awaiting surgery, and
improve their recovery1.
Around a third of over 45s in the
UK have sought treatment for
osteoarthritis, over 2 million for hip
osteoarthritis. The condition
causes pain, stiffness, limits
everyday activities and often leads
to joint resurfacing or replacement
surgery.
The NHS in England and Wales
carries out 60,000 such operations
1
Annals of the Rheumatic Diseases, The Eular Journal, BMJ, January 2015
A new approach
Recently published guidance from
the National Institute for Health
and Care Excellence (NICE)
suggests that non-invasive
treatments should be tried before
making a decision about
whether or not surgery is
appropriate.
Three core treatments are
recommended: education and
self-management, local muscle
strengthening and general
aerobic fitness, and, where
relevant, interventions to
achieve weight loss.
The Cycling Against Hip Pain
programme was conceived by
consultant orthopaedic surgeon
Robert Middleton, and
physiotherapist Tom Wainwright,
as an effective way to
implement NICE guidelines.
The six-week programme was
set up jointly by BH Live, Royal
Bournemouth and Christchurch
Hospitals NHS Foundation Trust
(RBCHFT), Dorset Clinical
Commissioning Group, Active
Dorset, Bournemouth Borough
Council and Bournemouth
University.
The programme incorporated
exercise for strength, mobility
and pain relief, and expert
advice to help people monitor,
manage and improve their
condition through exercise and
changes in diet and lifestyle.
Each week, groups of up to 15
people attended a 30-minute
education session with a
physiotherapist, followed by a
30-minute exercise class on
static bikes.
Each person was also given an
exercise programme to do at home, encouraged to cycle when
they could and asked to keep a
diary to keep them on track once
they had completed the
programme.
Participants were assessed before
and after the programme in terms
of pain, function and range of
motion, and included tests on the
Wattbike to assess power output
and pedalling technique.
The results
The CHAIN programme ran
between October 2013 and April
2015. Of the 119 people referred
onto the programme, 96 went on
to complete it.
The post-programme assessment
showed a remarkable
improvement for many who took
part, with many reporting improved
flexibility, less pain, less
dependence on analgesics,
improved sleep, feeling fitter and
stronger, and better able to carry
out activities of daily living.
They also grew in confidence and
wellbeing, made important lifestyle
changes and learned how to make
exercise an enjoyable habit.
A case study published in the BMJ
Case Reports in February 2015
describes how a 71-year old man,
despite a complex range of
medical conditions, took part in the
CHAIN programme and reported
an “amazing difference” in the
strength and use of his right leg,
and in his physiological welfare
and fitness.
Six weeks after the programme he
was cycling around town for at
least 15 minutes a day and
walking his dogs.
“The programme made me realise
that exercise was the best way to
improve my pain and the use of
my leg,” he says.
“It has made such a difference to
me. I can now turn over in bed at
night without having pain. I am
determined to keep up with the
exercise. Sometimes I don’t want
to go out and walk the dogs, but
once I am halfway through my
walk I realise that I am walking
more easily.
“I think it is important that you stick
with the programme and the
exercise. It is tough the first couple
of sessions, but you need to see it
through to get the benefits, and to
acquire the knowledge and advice
that will help.
“It is also really positive that it is
done in a local leisure centre. I
never realised how much support
was on offer at these places, and
the enthusiasm for exercise at the
centre was really infectious.”
About BH Live
BH Live is the South Coast’s
leading operator of leisure and
event venues – a social enterprise
that designs and builds engaging
experiences to inspire people and
enrich lives.
bhlive.org.uk